Patient Accounts Specialist- Insurance

Emerus; United States; Remote; USD 42,000 - 54,000; Full time

Job summary

Emerus, the leader in small-format hospitals, seeks an accounts receivable/billing specialist to help manage outstanding receivables and ensure timely reimbursement from payers. You will follow up on claims, resolve denials, and support AR reporting while handling refund requests and project work.

The role requires attention to detail, English proficiency, and experience with medical records or patient accounting systems in a healthcare setting. Healthcare billing knowledge is essential.

Qualifications

• Fluency in English; written and oral communication required.
• Experience in a provider setting (inpatient or outpatient) preferred.
• Knowledge of payer mix, including commercial insurance, Medicare, and self-pay, and related billing processes.
• Experience with medical records or patient accounting systems.
• Familiarity with state and Federal payment laws and healthcare explanations of benefits (EOBs).
• Experience using a 10-key adding machine.

Responsibilities

• Follow up on submitted claims (received, pending, processing, paid) to ensure timely reimbursement.
• Communicate with payers regarding delinquent or denied claims and resolve issues.
• Verify accurate reimbursement and initiate adjustments or appeals on disputes.
• File appeals for denied claims and follow up through resolution.
• Manage outstanding patient balances and AR reporting.
• Verify benefits and ensure claims are processed to the correct benefit levels.
• Submit refund requests as necessary.
• Support special projects as assigned by supervisor/director/CFO.

Skills

Fluency in English

Written and oral communication

Provider-setting experience

Education

High School Diploma or GED

Tools

10-key adding machine

Job description

About Us

We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

Position Overview

The purpose of this position is to assist in managing the company’s outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.

Essential Job Functions

• Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Manage claim details and verify accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes
• File appeals for denied claims and follow-up as necessary through appeal resolution
• Manage and maintain outstanding patient balances to ensure accurate reporting of company’s accounts receivable
• Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
• Submit refund requests as necessary
• Works special projects as assigned by Supervisor/Director/CFO

Other Job Functions

• Meet position’s goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned
• Willingness and ability to work overtime

Basic Qualifications

• High School Diploma or GED, required
• 2+ years experience in a provider setting (inpatient or outpatient), required
• Knowledge of all payors insurance; self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third party billing, required
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws, required
• Knowledge and understanding of healthcare ‘explanation of benefits’ (EOB’s), required
• Experience with a 10-key adding machine, required
• Position requires fluency in English; written and oral communication